Rebecca Lipe experienced abdominal discomfort on deployment in Iraq in 2011. But two years passed before Rebecca, then 27-year-old Air Force Captain Rebecca Lipe, identified what was causing it and underwent multiple misdiagnoses and treatments before ultimately opting to have a hysterectomy performed.
Lipe’s situation was extreme, yet her suffering is not unheard of; chronic pelvic pain is prevalent among female veterans who have experienced combat trauma, posttraumatic stress disorder (PTSD) or military sexual trauma, according to VA statistics.
Chronic pelvic pain refers to any discomfort in the lower abdomen, genital area, lower back or thighs that lasts more than six months and could include:
Irritable Bowel Syndrome (IBS), Interstitial Cystitis (Bladder Pain Syndrome), Pelvic Floor Dysfunction and Endometriosis can all increase your chances of pelvic injury or surgery.
Vulvodynia (chronic vaginal pain) and cysts on the ovaries may both increase.
Combination of Facts
Lipe is no exception when it comes to women assigned female at birth (AFAB), facing long and difficult journeys to receive proper diagnosis and effective treatments that require standing up for yourself even when no one else will.
Watch: Expert Opinion – Know Your Patient Rights
“Pelvic pain can often go misdiagnosed for various reasons,” noted Mandi Murtaugh, DPT, WCS of Tacoma, Washington. She stated there is plenty of literature showing women aren’t taken seriously or need several specialists before one listens. Additionally, many military members feel as if they must ignore pain if it arises – this attitude means listening to your body is often out of the question as their job requires them to remain strong against it, according to Murtaugh.
People may also hesitate to discuss pelvic pain with their provider as it makes them uncomfortable or they fear they won’t find support from them, while racial bias in OB-GYN care (and medical care in general) makes diagnosis and treatment all the more challenging for women of color.
Lipe was a judge advocate general in the Air Force. When she visited base doctors in Iraq for help, they assumed she had sexually transmitted infection even as she insisted it was unlikely given she was married and faithful to her partner. Lipe found the experience intrusive and humiliating:
As her pain worsened, Lipe was medically evacuated to Germany by the military where doctors simply diagnosed menstrual cramps as the source of her suffering and refused to admit her, even though she could barely stand.
“Because they couldn’t see my wound, they assumed it wasn’t as severe, as most injuries you can’t see don’t get treated.
An analysis from the Armed Forces Health Surveillance Center released in 2010 — just one year before Lipe was medically evacuated — revealed that only 1 out of every 5 medical evacuations of troops from Iraq and Afghanistan in the last eight years was related to battle injuries, according to Stars & Stripes, an independent military newspaper. Most were classified as having occurred outside battlefield conditions: back and knee problems; mental disorders; digestive, respiratory or urinary symptoms – 15 out of every 100 evacuations had something to do with genitourinary organ disorders related to problems caused by servicewomen/service members being medically evacuated due to these disorders AFAB.
2021 military report concluded that female service members experienced higher percentages of medical evacuations for mental health disorders and genitourinary system disorders than their male counterparts in 2020, particularly problems related to genital and urinary organs, accounting for 4.3% compared with 2.3% among male evacuations from U.S. Central Command area of responsibility.
Lipe was only admitted to Landstuhl Regional Medical Center in Germany after intervention by her command’s medical liaison. While there, she was diagnosed with an infection from Iraq; they prescribed her malaria medicine which did not work and then medically evacuated back home.
Over the next year, she underwent multiple procedures – none of which provided answers or relief from her pain. One doctor suggested endometriosis as being responsible and prescribed hormone-depleting medications as treatment options.
Watch: What Is Endometriosis?
“This experience took an immense toll on me mentally; I no longer wanted to live because no one was listening,” Lipe recounted. Eventually, after around one year had gone by, a military doctor realized they weren’t getting her the proper medical assistance; finally she found answers with help from one doctor after another.
Lipe was initially referred to civilian doctors at University of Florida Health; then to a reproductive endocrinologist; there, her discomfort was determined to have stemmed from undiagnosed hernias caused by improperly fitting body armor.
Even though Lipe hadn’t noticed it at the time, she’d spent many hours wearing armor that pressed against her abdomen wall during convoys that required sitting at an angle. Because much of military equipment had been designed around a male body type, she had to remove its side panels and place foam rubber pads under her shoulders to protect her vital organs; otherwise, its ballistic plates would tear into her abdominal wall while traveling.
Lipe underwent surgery to address her hernias and clear away scar tissue left over from previous treatments, but by then the damage had already been done – vaginal atrophy became a side effect from medications prescribed to treat endometriosis – something she never actually had!
Lipe was on hormone therapy for another year in order to bring her hormone levels back up where they should be, when her husband and she began discussing having children together. IVF would be necessary as intercourse could no longer bear its pain,” Lipe recalled.
After her sixth IVF treatment, Lipe became pregnant and gave birth. If they had diagnosed her early enough, surgery to repair hernias would have been done immediately and her life back on track; unfortunately however, Lipe said the medications had wreaked havoc with her body leading to an eventual hysterectomy procedure being needed to ensure she could still bear children.
Lipe still struggles with pelvic pain today, although her symptoms have lessened. “It’s still an ongoing battle,” she noted, though perhaps not as intensely.
Watch: Reducing Pelvic Pain for Servicewomen
Unfortunately, reproductive health issues like pelvic pain will only worsen without adequate treatment. Unfortunately, the medical system demands diagnosis; tests and MRIs don’t reach the pelvic floor,” according to Murtaugh. Furthermore, their schedule requires patients be seen and out within 15 minutes without providers taking time to listen or understand a story behind patient needs – this often becomes a traumatic experience in an attempt to access care.
Murtaugh suggested seeking out both a physical therapist who specializes in pelvic pain management and an open-minded physician as resources for pelvic discomfort relief. If waiting to see an orthopedic specialist is an issue for you, she advised seeing a physical therapist first in order to ease symptoms as soon as possible.
“We can get you treatment along the way. I find it heartbreaking when someone has been waiting for multiple specialists. Sometimes surgeons suggest going first to a physical therapist,” Murtaugh noted.
Represent yourself, she advised.
“Lipe’s advice was also pertinent: she needed to stand up for herself even though it wasn’t popular; eventually though, her persistence paid off.”